Rural Iowa Redesign of Care Delivery with EHR Functions
Project Final Report (PDF, 144.65 KB) Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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Project Details -
Completed
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Grant NumberUC1 HS015196
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AHRQ Funded Amount$1,492,374
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Principal Investigator(s)
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Organization
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LocationMason CityIowa
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Project Dates09/30/2004 - 12/31/2007
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Care Setting
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Population
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Type of Care
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Health Care Theme
The purpose of this project was to evaluate the impact of implementing electronic health record (EHR) functions on patient care and organizational culture in rural health care hospital inpatient units, ambulatory care, and two primary care clinics. The partners implemented a comprehensive integrated EHR using computerized provider order entry (CPOE), interdisciplinary documentation, medication administration scanning, and clinical decision support (CDS) tools in a planned one-day "big-bang" approach. A time-series design was used to evaluate effect on reported errors (medication errors); CMS/ Joint Commission quality measures; computerized ordering and decision support tools; emergency length of stay; and clinician/staff assessment of the implementation process and how the EHR has changed the quality and safety of patient care, communication among clinicians and patients; and daily work life. After thirty months the hospital and clinics had sustained a 70 percent CPOE rate with over 250 evidence-based order sets; 76 CDS rules; redesigned all patient-centered workflow processes to include quick registration, up-to-date medication lists, technical and content safety and error-prevention designs with required documentation. The partners improved timely antibiotic use and patient education CMS indicators while maintained others in the top quartile; maintained organizational engagement; and found no untoward consequences during the changes.
Citation: Brokel JM, Ward MM, Wakefield DS, et al. Changing patient care orders from paper to computerized provider order entry-based process. Comput Inform Nurs 2012 Aug;30(8):417-25.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Descriptive
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Rural Populations
Citation: Brokel JM, Schwichtenberg TJ, Wakefield DS, et al. Evaluating clinical decision support rules as an intervention in clinician workflows with technology. Comput Inform Nurs 2011 Jan-Feb;29(1):36-42.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Descriptive
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Rural Populations
Citation: Roberts LL, Ward MM, Brokel JM, et al. Impact of health information technology on detection of potential adverse drug events at the ordering stage. Am J Health Syst Pharm 2010 Nov 1;67(21):1838-46.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Pre-Post Study
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Adults, Individuals with Chronic Care Needs
Citation: Vartak S, Crandall DK, Brokel JM, et al. Transformation of emergency department processes of care with EHR, CPOE, and ER event tracking systems. HIM J 2009;38(2):27-32. PMID: 19546485.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Chart Review, Interview, Mixed Methods, Pre-Post Study
Technology: Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record, Emergency Department Information System
Population: Clinical Staff/Clinician, Patient
Citation: Wakefield DS, Wakefield BJ. Are verbal orders a threat to patient safety? Qual Saf Health Care 2009 Jun;18(3):165-8. PMID: 19467996.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Systematic Review
Technology: Computerized Provider Order Entry System
Citation: Brokel JM, Harrison MI. Redesigning care processes using an electronic health record: a system's experience. Jt Comm J Qual Patient Saf 2009 Feb;35(2):82-92. PMID: 19241728.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Case Study
Citation: Halbesleben JR, Wakefield DS, Ward MM, et al. The relationship between super users' attitudes and employee experiences with clinical information systems. Med Care Res Rev 2009 Feb;66(1):82-96.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Cross-Sectional (Prevalence) Study
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Medically Underserved Populations, Vulnerable Population
Citation: Wakefield DS, Brokel J, Ward MM, et al. An exploratory study measuring verbal order content and context. Qual Saf Health Care 2009 Jun;18(3):169-73.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Descriptive
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Medicaid, Vulnerable Population
Citation: Crandall DK. Rural Iowa Redesign of Care Delivery with EHR Functions - Final Report. (Prepared by Mercy Medical Center North Iowa under Grant No. UC1 HS015196). Rockville, MD: Agency for Healthcare Research and Quality, 2008.
Link:
uc1hs015196-crandall-final-report-2007.pdf
(144.65 KB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Report
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Individuals with Chronic Care Needs, Rural Populations
Citation: Wakefield DS, Ward MM, Groath D, et al. Complexity of medication-related verbal orders. Am J Med Qual 2008 Jan-Feb;23(1):7-17.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Descriptive
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Medically Underserved Populations, Vulnerable Population
Citation: Wakefield DS, Halbesleben JR, Ward MM, et al. Development of a measure of clinical information systems expectations and experiences. Med Care 2007 Sep;45(9):884-90.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Cross-Sectional (Prevalence) Study
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Medically Underserved Populations, Vulnerable Population
Citation: Brokel J. Creating sustainability of clinical information systems: the chief nurse officer and nurse informatics specialist roles. J Nurs Adm. 2007 Jan; 37(1):10-3.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication, Editorial
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Medically Underserved Populations, Vulnerable Population
Citation: Crandall DK, Brokel JM, Schwichtenberg T, et al. Redesigning care delivery through health IT implementation. Exploring Trinity health's IT model. J Healthc Inf Manag 2007 Fall;21(4):41-8.
Principal Investigator: Crandall, Donald
Project Name: Rural Iowa Redesign of Care Delivery with EHR Functions
Document Type: Journal Publication
Research Method: Descriptive
Technology: Clinical Decision Support System, Computerized Provider Order Entry System, Electronic Health Record/Electronic Medical Record
Population: Medically Underserved Populations, Vulnerable Population
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Citation: Hook JM, Grant E, Samarth A. Health Information Technology and Health Information Exchange Implementation in Rural and Underserved Areas: Findings from the AHRQ Health IT Portfolio. AHRQ Publication No. 10-0047-EF. Rockville MD: Agency for Healthcare Research and Quality. February 2010.
Technology: Health Information Exchange
Citation: Dixon BE, Zafar A. Inpatient Computerized Provider Order Entry (CPOE): Findings from the AHRQ Portfolio (Prepared by the AHRQ National Resource Center for Health IT under Contract No. 290-04-0016). AHRQ Publication No. 09-0031-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2009.
Link:
Inpatient Computerized Provider Order Entry (CPOE): Findings from the AHRQ Health IT Portfolio
Technology: Computerized Provider Order Entry System
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